How We Manage Gastrointestinal Symptoms During Oral Immunotherapy Through a Shared Decision-Making Process-A Practical Guide for the Community Practitioner

Gilbert T Chua; Edmond S Chan; Rosemary Invik; Lianne Soller; Vishal Avinashi; Stephanie C Erdle; Tiffany Wong; Victoria E Cook; Raymond Mak; Scott B Cameron

doi:10.1016/j.jaip.2022.11.015

How We Manage Gastrointestinal Symptoms During Oral Immunotherapy Through a Shared Decision-Making Process-A Practical Guide for the Community Practitioner

J Allergy Clin Immunol Pract. 2023 Apr;11(4):1049-1055. doi: 10.1016/j.jaip.2022.11.015. Epub 2022 Dec 5.

Authors

Affiliations

¹ Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China; Allergy Centre, Union Hospital, Hong Kong SAR, China; Department of Paediatrics, The University of Hong Kong Shenzhen Hospital, Shenzhen, China. Electronic address: [email protected].
² Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada.
³ Community Allergy Clinic, Victoria, BC, Canada.
⁴ British Columbia Children's Hospital Research Institute and the University of British Columbia, Vancouver, BC, Canada; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada.
⁵ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
⁶ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada.

PMID: 36470519
DOI: 10.1016/j.jaip.2022.11.015

Abstract

Allergists addressing gastrointestinal (GI) symptoms during oral immunotherapy (OIT) may be biased toward diagnoses related to OIT; however, non-OIT causes may occur. Although there is currently a lack of robust data for evidence-based treatment recommendations, we provide 3 real-world illustrative cases along with a proposed management algorithm for GI symptoms encountered during OIT. This algorithm was developed because of a significant clinical need, given the number of new-to-OIT providers that include practicing allergists, trainees transitioning into practice, and allied health care providers who manage GI symptoms in OIT patients. We developed the algorithm based on the opinions of community and academic allergy clinics across Canada with significant clinical experience offering infant, preschool, and school-aged OIT patients, with gastroenterologist input. Further research is needed to fill the knowledge gaps in the management of GI symptoms during OIT before formal recommendations can be suggested.

Keywords: Eosinophilic gastrointestinal diseases; Gastrointestinal symptoms; Oral immunotherapy; Shared decision-making.

MeSH terms

Administration, Oral
Allergens / therapeutic use
Canada
Child
Child, Preschool
Desensitization, Immunologic
Food Hypersensitivity* / drug therapy
Humans
Infant

Substances

Allergens